BY 


: SHBARMAN PETERKIN, M.D., F. A.C. S. 


| SEATTLE, WASHINGTON 


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A y 
4 4 
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INSTRUCTIONS 


FOR 
RECUMBENT OR HOSPITAL TREATMENT 


OF 


ACUTE GONORRHEA 
IN THE MALE 


DECEMBER, 1918 


BY 
G. SHEARMAN PETERKIN, M. D., F. A. C. S. 
SEATTLE, WASHINGTON 


| COPYRIGHTED ~ eh 
ae . August, 1919 erates 


By Guy Shearman Peterkin a 


CAbe ( 
urn of @ ana 7 UAH Lf 


CONTENTS 


Page 
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aot eiearOlsnlOm ALE LOT NAKING LM JeCtLONS 0c..5 2c -0-s. tints ee coos don stdeenste se Lt 
Pisieiciones.oL amen Ore lrrigatme «Wrathrayi.) tog). ae 12 
ieetroneArticles, NUlsers tar, repare. tor Patient 18.282 See. 14 


Preface to Diagrammatic Drawing of Male Sexual and Urinary Organs 19 
Explanatory Key to Diagrammatic Drawing of Male Sexual and Urin- 


ary Organs, Showing Their Relative Positions and Functions.......... 2h 


APPENDIX 


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Pee MOCO) sD OTALOT Y) MAMOINO Bie eg yeas ce rece ren cs tue hiccteeny 24 
Speculsinstructions.of Attending Physictant: cule ks 8 25 


Fig. L. 
1 amare © 
Fig. oe 
Hig: eEW 
Fig. Vi, 
Jip hea, hi AVAL 
Fig. sve 
Fig. VIII. 
Hig 
Fig. DXi 
Bigeye 
Fig. XII. 
Migs XA: 
Hig) XB. 
Big XV. 
Fig. XVI. 


LIST OF ILLUSTRATIONS 


Basin containing 1-4000 bichloride solution and 
COLTON: Sponge, ‘see pave Det ae (eae ee 
Crepe paper towels for wiping hands, see pages 
By ATV UV NAVI PI Re 
Quart Mason Fruit Jar containing 1-500 bi- 
chloride solution for sterilizing soiled dressings, 
SOG AWC Oats Sie toes Uo te NT ae aca a a 


Cotton, gauze and oil silk to be applied at meatus, 
SOC PAW OO Leer cola a) As a ee Ue ee 


PAGE— 
16 
16 


16 
16 


Showing suspensory with safety-pin in flap to . 


keep dressing in place, see page 6.000. 
Genito-urinary suspensory devised by Dr. 
Peterkin, showing size of opening that will 
not. constrict organ, see page 6. Lau eae 
Non-piston syringe with bulb advised for ‘ure- 
thral injections; ‘see page:S:.00 i. (A) ae 
Condiment bottle for sterilizing syringe, con- 


Le 


Li 


17 


taining envelope and bichloride tablet, see 


DATO Bley eA Ss a Mee ome ea 


Urethral syringe being sterilized—showing depth 


of antiseptic in bottle, see page 8.000. 
Four-ounce condiment bottle containing medi- 
cine for injection, see pages 8 and 11.0. 
Boracic Acid solution for sterilized syringe, see 
PATS TA sy WOU NORE eV TA ei il eareceen ey A 
Table, arranged for patient’s bedside, containing 
all. requisites for treatment..2000 0 
Same as Fig. XII but covered to keep out dust 
and. other:foreign particles apne si bee 
Diagrammatic drawing of table MICE 
with ‘explanatory skeyee ea hii oy 
Glass nozzles, two, for irrigating. 
Diagrammatic drawing of male sexual and urinary 
organs showing their relative positions, the 
body cut in half from before backwards................. 


Ag 
17 
17 
17 
18 
18 
Bok 
18 


20 


«* 


This pamphlet in a practical so 
and utilitarian way outlines the uses 
Standardtreatment for acute 3) )a.8 
gonorrheal urethritis in the | | 
male. < Meee | 


It is a concise manual for a 
physician, nurse, patient and 
hospital. = 


THE PROEM 


AOe 


“The tune has come the walrus said, 
To talk of many things, 

Of shoes and ships and sealing wax; 
And cabbages and kings.’’ 


SLO 


There are forces at work in the world today which medical men cannot 
afford to ignore. No longer is it possible to cling with safety to the super- 
annuated standard of Medical Ethics—a standard which erects an artificial 
barrier between medicine and the applied sciences. As elsewhere, HFEF I- 
CIENCY PRINCIPLES must govern the scientific treatment of disease. 


A PRESENTATION OF THIS PROBLEM RESOLVES ITSELF INTO: 


1. The creation of a standard. 


2. An economic organization of workers, material, time 
and methods so as not only to attain, but maintain this 
standard. 


The creation of an increased demand for scientific med- 
icine as against pseudo-scientific medicine. 


OS 


4. A demonstration of the proposition. 


Standard is created through application of principles of every natural 
law that governs the treatment of disease. 


Systematic, economic organization, by reducing costs, will place scientific 
medicine within the purchasing power of all of the people. 


An increased demand for scientific medicine will be obtained by such ad- 
vertising as will enable the public to differentiate between scientific and pseu- 
do-scientific medicine. Such a demand on the part of the publie will become 
erystallized when the profession of medicine has created a standard of pro- 
cedure so worded, illustrated, arranged and systematized that it will appeal 
to the intelligence and logic of the layman’s mind, rather than to his emo- 
tions. Then the public can and will make this differentiation and will de- 
mand scientific, economic treatment based on EFFICIENCY PRINCIPLES 


and not on tradition or obsolete theories. 
I. 


2 INSTRUCTIONS FOR RECUMBENT OR HOSPITAL 


Increased demand will bring the physician more patients because it will 
make such treatment accessible to a larger group of people. An increased 
volume of business without a corresponding increase in overhead expense will 
bring an increased profit to the physician, reduce costs of scientific treat- 
ment and place such treatment within the reach of a greater proportion of 
the public. 


To demonstrate the proposition: HFFICIENCY PRINCIPLES must 
govern scientific treatment of disease, the author has selected the disease of 
gonorrhea, because: 


1. It is a universal disease, hence of interest to the ma- 
jority. 


bo 


Its existence is so detrimental to social, civic and eco- 
nomic welfare that the Federal Government deems it 
essential to maintain an active educational propaganda 
against it. 

It is rarely scientifically treated due to the false mod- 
esty which surrounds sex problems. 


we 


Therefore, if it can be demonstrated that EFFICIENCY PRINCIPLES 
are applicable to a disease of such importance, the advisability of applying 
the same principles to other diseases would seem sufficiently self-evident. 


In the present status of scientific knowledge, the efficient, therefore stand- 
ard, method of dealing with gonorrhea is recumbent or hospital treatment. 

This form of treatment alone permits recognition of and compliance 
with the principles of the immutable laws of nature, whether physiologic, 
biologic, anatomic, therapeutic, hygienic, economic, governing the disease. 


Under present conditions, however, when the physician attempts to cope 
with this disease, he faces two alternatives. He may send the patient to 
a hospital where he will receive such treatment as hospital facilities now offer, 
the expense of which in time and money is usually beyond the ability of the 
average person to meet; or the physician may give such time and treatment 
in his offices as he can afford for the compensation received and rely on the pa- 
tient’s ability to further follow out instructions. 


Neither of these methods brings results, and as a consequence, the disease 
is made an ever-increasing menace to humanity. Yet this condition of affairs 


is totally unnecessary. 


Systematic, economic organization while omitting no essential detail will 


TREATMENT OF ACUTE GONORRHEA IN THE MALE | 3 


bring hospital treatment within the purchasing power of any individual. The 
truth of this assertion is emphasized by the following: 


1. Ninety-eight per cent of all nursing is done and will 
continue to be done by women. Any logical pretext 
which may exist for the prudery and false modesty 
that surrounds the nursing of this disease by the 
female nurse, thus increasing the cost of treatment 
by the unnecessary employment of a special attend- 
ant, is removed by the systematic arrangement of the 
details of treatment, with the result that any female 
nurse can attend a patient so afflicted without any 
loss to her self-respect. 


bo 


The method is so systematized that no hospital can 
charge exorbitant prices or refuse admission to gon- 
orrheal patients, either on the grounds of pseudo-mor- 
ality or increased cost of caring for an infectious dis- 
ease of this character. 


3. Iifficiency in treatment is attained by a clear and con- 
cise outline of the duties of physician, nurse and pa- 
tient. Responsibility is definitely placed and any neg- 
lect of duty readily detected and rectified. Cost is 
reduced through the saving of time, money and en- 
ergy to the physician, nurse, patient and hospital. 


(See page 10, ‘‘Duties of Physician,’’ ‘‘Duties of 
Nurse,’’ and ‘‘Duties of Patient.’’) 


It is believed that a large part of this information finds accessible expres- 
sion for the first time, and that Recumbent or Hospital Treatment of Gon- 
orrhea as here outlined must be accepted as a Standard Treatment of this 
disease, because it is worded, illustrated, arranged and systematized to ap- 
peal to the intelligence and logic of the people and yet comply with the prin- 
ciples of every natural law governing the treatment of gonorrhea. 


THH AUTHOR. 
Seattle, December, 1918. 


* “Scientific knowledge logically applied to acute gonorrhea in the male urethra.’—Medical 
Record, Jan. 16, 1915. 


INSTRUCTIONS FOR RECUMBENT OR HOSPITAL 
TREATMENT OF ACUTE GONORRHEA 
IN THE MALE 


GENERAL INSTRUCTIONS 


The patient must be confined to bed. 
Gonorrhea is not contagious. 


Gonorrhea is communicable only 
when the germs are carried to the 
mucous membrane of the urinary 
tract, sexual organs, eyes and rectum. 
Therefore, carefully observe the fol- 
lowing precautions: 

PATIENT AND NURSE MUST NOT PER- 
MIT HANDS TO COME IN CONTACT WITH 
FACE, ESPECIALLY THE EYES, for dis- 
charge entering the mucous membrane 
of EYES will cause IMMEDIATE BLIND- 
NESS. 


Ir THERE IS ANY IRRITATION OF EYES 
OF PATIENT OR NURSE, REPORT IMMEDI- 
ATELY TO PHYSICIAN. 


The nurse, in handling dressings or 
bed-linen, need not wear gloves. It is 
essential that she keep her hands 
from her face and wash hands thor- 
oughly with soap and hot water im- 
mediately on finishing her task. After 
washing hands, towel or linen used 
must be put where there is no danger 
of anyone using it before it is laun- 
dered. | 

Place on bedside table, within easy 
reach of patient: 

1. Twelve pieces of loose cotton 
about size of a dollar in basin 
(Fig. I) containing 1/4000 bi- 
chloride solution. If this strength 
irritates, use 1/6000 or 1/10,000. 

If bichloride tablets are used, 
see that they are thoroughly dis- 
solved, so that solution is uniform 


in strength; otherwise severe irri- 
tation of the mucous membrane 
might occur. 


bo 


In a second basin or other conven- 
ient receptacle, place twenty 6-inch 
squares of non-sterile gauze, to be 
used by patient as towels for dry- 
ing fingers after dressing the or- 
gan. Each time after using a 
square, patient should place it in 
fruit-jar for soiled dressings. 
(Fig. IIT.) 

To reduce cost, pieces of crepe 
paper toweling neatly folded may 
be substituted for gauze and ba- 
Slee hip Lh) 

A quart Mason fruit-jar one-half 
filled with 1/500 bichloride solu- 
tion. Empty and change solution 
daily—more frequently if neces- 
sary. Label jar: ‘‘Poison—for 
soiled dressings only.’’ (Fig. III.) 


wo 


Patient is to take a piece of cotton 
from basin (Fig. I.), squeeze out ex- 
cess of solution, and place cotton so 
as to cover well mouth of penis 
(meatus). 

If a long foreskin is present, pull 
it over moist cotton to keep cotton in 
place. Do not put in a thick piece. 
Do not pack it too closely against 
mouth of organ; this will prevent es- 
cape of discharge (free drainage). 

If foreskin is short or absent, pa- 
tient should wear a suspensory that 
will retain the dressing in place with- 
out constricting the organ. 


6 : InNstTRUCTIONS FoR RECUMBENT OR HOSPITAL 


To dress penis without foreskin em- 
ploy moist medicated cotton as di- 
rected; use a piece large enough to 
cover well the area around meatus. 
Over cotton place a 5-inch square of 
gauze, over gauze a 95-inch square of 
oil silk. (Fig. IV.) Wrap both loose- 
ly about the organ, then button flap 
of suspensory so as to keep dressing 
in place. 


In case the space in flap of suspen- 
sory is too big to hold dressing in 
position loosely about meatus, use a 
safety-pin, sticking it through flap on 
left side. (Fig. V.) Placing dress- 
ing too close or tight about meatus 
prevents escape of discharge and ster- 
ilization of bacteria by antiseptic on 
cotton. 


Patient should: 


1. Change dressings about meatus 
every two hours (more frequently 
if discharge is profuse); also af- 
ter each act of urination. 

Sponge head of organ thoroughly 

with bichloride solution at each 

change of dressing. 

3. Pull foreskin (if present) well 
back so that glands can be thor- 
oughly cleaned. 

4. Place soiled dressings and cotton 
at once in jar provided for this 
purpose. 

5. Dip fingers in bichloride solution 
immediately after changing dress- 
ing or handling organ. Dry fin- 
gers on gauze sponge or crepe 
paper toweling, which is then 
placed in fruit-jar labeled ‘‘Poi- 
son—for soiled dressings.’’ (Fig. 
19 By) 


The suspensory, oil silk, and gauze 
dressings should be used by every pa- 
tient abed, especially at night. These 
prevent dressings from contaminating 
bed-linen or patient’s clothes by get- 
ting displaced or lost among them. 
GCA Ba) 


i) 


The object of medicated cotton is 
LON 
1. Destroy gonococci (germs of gon- 
orrhea) that are discharged from 
mouth of urinary canal, and 
thus prevent the inflamed and 
everted mucous membrane at 
mouth (meatus) from reinfecting 
urinary canal, through being 
bathed in this discharge contain- 
ing active instead of dead organ- 
isms. 
Prevent pus-producing micro-or- 
ganisms, always present on out- 
er side of meatus, from enter- 
ing urethra and causing mixed 
infection. This mixed infection 
is the chief cause preventing an 
early cure of gonorrhea. In other 
words, to the inflamed urinary 
canal is to be applied the general 
surgical principle of keeping 
every wound sterile and prevent- 
ing reinfection by suitable dress- 
ings. 


bo 


‘3. Prevent discharge caking up mea- 


tus, thus interfering with free 
drainage. 

4. Prevent extra-genital infection 
and infection of the eyes, by ap- 
plying an antiseptic and destroy- 
ing germs as soon as they escape 
from the inflamed organ. 


Erections aggravate and prolong 
the disease by producing congestion 
of the inflamed lining membrane of 
urinary canal, causing swelling and 
edema, preventing escape of dis- 
charge (free drainage) and. interfer- 
ing with the attacking hosts of the 
body that are trying to repel and de- 
stroy the invading gonococci. There- 
fore strictly observe the following: 

1. Avoid sexual intercourse, kissing, 
loving, all scenes, exhibitions, 
literature, conversation and com- 
pany that will cause sexual ex- 
citement. 


See illustrations pp. 16 and 17. 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 


2. Avoid sleeping under heavy cov- 
ering or on light-weight mattress. 
Sleep on a hard bed; use little 
covering, because erection may 
take place if body becomes over- 
heated. 

Lying on back while asleep may 

cause erection; if it does, patient 

should avoid this position while 
sleeping. He can do so by tying 

a towel around his waist, knotting 

it in the back so that he will 

awaken when he lies on knot. 

4. Avoid erection by wearing a prop- 
erly fitting suspensory, with an 
opening (through which the organ 
is put) large enough not to con- 
strict the organ either when in re- 
pose or when erection takes place. 
Such an opening is well illustrated 
MEP VL. 


If, after following hygienic instruc- 
tions as given above, erections still 
occur, patient should ring for ice-bag 
and place it over sexual organs. 

Never strip or squeeze organ to see 
if discharge has stopped. By rubbing 
the inflamed membranes together this 
act causes congestion, bruises the in- 
flamed tissue and thus aggravates the 
inflammation and retards recovery. 


we) 


DIET. 


Avoid fried-stuffs, red meats, acid 
fruits, pastry, rhubarb, asparagus, 
tomatoes, and condiments such as 
mustard, pepper and horseradish and 
stimulating sauces. Light meals only 
should be taken, and patient should 
never overeat. Less food is required 
while lying in bed and not exercising, 
and digestive tract should not be over- 
worked. In fact, the lhght diet as 
served in hospitals may be followed 
in preference to regular diet as here 
modified. 

Take absolutely no alcohol; use to- 
bacco moderately, not more than three 
cigars or equivalent daily. . 


“I 


Drink at least eight glasses of 
water daily. (Do not use carbonated © 
water). <A pitcher of water with 
drinking glass should be placed with- 
in patient’s reach so that he can take 
the fluid freely and regularly. 

The object of taking this amount of 
water is to: 
1. Prevent congestion and _ irrita- 

tion of the inflamed mucous 
membrane by concentrated or acid 
urine, which acts like pouring 
vinegar over an inflamed or open 
cut. 

2. Wash out the accumulated dis- 
‘charge and gonococci in the canal, 
thus facilitating drainage and de- 
stroying the rapidly breeding or- 
ganism, which cannot live outside 
the human body. 

The amount of water to be taken by 
every individual will vary. The means 
of regulating the quantity is as follows: 
The urine must be bland (alkaline). 
Therefore, after each act of urination, 
if patient complains of frequency 
or of burning sensation on urination, 
nurse should drop a piece of red lt- 
mus paper into urinary receptacle; if 
the paper turns blue a_ sufficient 
amount of water is being taken; if it 
does not, the amount of water should 
be increased until the litmus paper 
turns blue readily. 


TREATMENT. 


After doctor has given instructions, 
patient is to treat himself. The nurse 
is simply to supply the articles neces- 
sary for treatment, and through her 
intelligent knowledge of treatment 
and orders given, supervision of 
baths, medication, etc., see that the 
orders are carried out as per sched- 
ule, 

When the fact is borne in mind that 
the gonorrheal germs duplicate them- 
selves every fifteen minutes night and 


See illustrations p. 17. 


§ INSTRUCTIONS FoR RECUMBENT OR HOSPITAL 


day unless they are checked by per- 
sistent and regular treatment, the 
nurse and patient must realize the 
' necessity of applying this treatment 
regularly. This persistent and regu- 
lar treatment is not for 6 to 10 hours, 
but must continue throughout the 24 
hours of each day. There must be no 
deviation from this rule. 

Technique of local treatment: An- 
terior urethra is to be washed out 
with hot boracic acid solution, or 


at least every two hours during day 
and every four hours during night. 
(See Instructions to Patient for Tak- 
ing Injections, page 11. 

The syringe used for these injec- 
tions is to be of the non-piston kind, 
preferably a bulb syringe. (Fig. VII.) 
To prevent reinfection or mixed in- 
fection, syringe should be sterilized 
(cleaned) in the following manner 
after each treatment: 


Syringe should be boiled or thor- 
oughly cleansed by filling and refilling 
a number of times with very hot run- 
ning water. After this has been done, 
place syringe in glass bottle contain- 
ing bichloride solution marked: ‘‘ Poi- 
son —for sterilizing syringe. Don’t 
inject? GtHio), EX.) Inv ithessbottle 
there is originally an envelope con- 
taining bichloride tablets for making 
the solution and labeled: ‘‘ Poison — 
for external use only.’’ (Fig. VIII.) 
Remove this envelope from bottle and 
place one of the tablets init. Full bot- 
tle with hot tap water to the top of 
label. This is the amount of water to 
be used to dissolve the tablet. The 
solution is POISONOUS. Don’t in- 
ject. 

Instructions for keeping syringe 
sterile: The nurse is to keep syringe 
as per instructions, pp. 14 and 15; 
thus the responsibility of misusing 
the bichloride solution is placed on 
nurse. If patient cares for syringe, 
he should rinse it in the boracic acid 


solution previously used for injection, 
or in very hot water, and then place 
syringe in bichloride solution. Each 
time before using, syringe should be 
filled three or four times with hot 
running water, and washed off, to 
prevent bichloride solution in which 
it has been sterilized from being in- 
jected into the canal and burning and 
injuring it. 

Note: If instructions are given to irrigate 
instead of use syringe, directions given under 
“Instructions to Patient for Irrigating Ure- 
thra” are to be followed out. Page. 12. The 
instructions for keeping syringe sterile apply 
to glass nozzles, if these are supplied for ir- 
rigating urethra. 

After urinating and washing out 
canal with hot boracic acid  solu- 
tion patient should inject gently 1% 
ounce of medicine, or enough to thor- 
oughly distend anterior urethra. The 
medicated injections should be taken 
every two or four hours, according to 
the reaction produced on the mucous — 
membranes of each patient. Medi- 
cine: 4 of 1 per cent protargol solu- 


tion; Ore, Ss 


epee dg OE Sn OPE en ee ee This 
medicine should be held in the urethra 
for 10 minutes as directed, unless it 
causes irritation, in which case the 
doctor should be notified. 


HOT SITZ-BATHS. 


Two or more to be taken daily, 
in an ordinary bath-tub, if possible, 
so that legs can stretch and be cov- 
ered with water. The water should 
be allowed to go up to umbilicus or 
‘‘belly button.’’ The baths should 
have a temperature of 106° to 120° 
F., and last from 3 to 15 minutes. It 
is well to begin these baths at a tem- 
perature of 100° and gradually in- 
crease heat with each bath, until 
water is as hot as patient can bear. 
Temperature should be such as will 
cause redness of skin. 

Patient should be instructed to uri- 


See illustrations p. 17. 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 8) 


nate before getting into tub, to cleanse 
urethra, so that no discharge will get 
into tub. After each sitz-bath scald 
the tub with hot water so that no 
one else will catch the disease. Hot 
or even warm water kills this infect- 
ing organism. 

Be careful not to cool body sud- 
denly after bath. The tone of blood 
vessels should be restored gradually, 
instead of producing sudden contrac- 
tion by a chill, and destroying the 
good effect of bringing the blood to 
the surface and away from the dis- 
eased area. Chill can be prevented: 
1. By having hot water bottles in 

patient’s bed, seeing that he has 
slippers, and is thoroughly wrap- 
ped in blankets while going from 
bath to his room or bed. If pa- 
tient’s room has bath attached, 
and temperature of both is alike. 
you need not do this. 

2. When the condition is not very 
bad, by dashing a bucket of cold 
water over patient’s lumbar re- 
gion while he is still standing in 
bath-tub. 

If the hot sitz-bath makes patient 
perspire badly, then, as soon as per- 
spiration stops, he should immediate- 
ly drink from one to three cups of 
lukewarm water. The object is to 
dilute the urine and still keep it 
bland, thus making up for the amount 
of fluid lost through perspiration. 
If this is not done, the urine becomes 
concentrated and causes irritation of 
the inflamed mucous membrane, and 
to overcome this is the very reason 
the bath is taken. 

In the daytime during interim be- 
tween treatments a hot-water bottle 
should be applied to perineum and 
one to pubes. 


CONSTITUTIONAL TREATMENT 

Santal oil should be taken: two 5- 
min. capsules every two hours for 
eight doses; then one 5-min. capsule 
every four hours, provided patient 


has not already taken the eight doses 
and is on the four-hour dose. The 
object of this medication is exactly 
the same as that given for drinking 
water (p. 7). If this drug is fresh, 
it will not cause irritation of kidneys 
or backache. 

Sodium bicarb may be substituted 
for the santal oil, if the latter cannot 


be obtained fresh. Sodium biecarb dos- 


age may be regulated by testing urine 


‘with litmus paper to see that it is 


alkaline (the dose that keeps urine 
alkaline is the proper one), and it 
may therefore vary from one-half to 
one teaspoonful, in a glass of water 
every four hours. 


CARE OF BOWELS. 


First night on entering hospital, 
commencing two hours before bed- 
time, give 14 grain calomel every 15 
minutes for eight doses; next morn- 
ing 1 oz. magnesium sulphate. 


After the first day patient may take 
one teaspoonful Epsom salts night 
and morning, or one-half to one tea- 
spoonful fluid extract of cascara at 
night. There should be at least one 
free movement daily. If this medica- 
tion does not produce results give a 
high SS enema. No day should pass 
without movement. 


The object of this medication of 
bowels is not only to maintain normal 
resistance of the body by keeping up 
the activity of these organs, but also 
TOs 


1. Keep the bowels from clogging 
and throwing extra work on the 
already overtaxed and inflamed 
urinary tract. 

2. Keep bowel contents in a fluid 
state, so that when in the rectum 
they will not press against the 
inflamed sexual organs (prostate, 
urethra, and seminal vesicles), 
and by mechanical pressure ag- 
gravate the congestion which ex- 
ists. 


10 INSTRUCTIONS 


DUTIES OF PHYSICIAN, NURSE AND PATIENT 


(A) The duties of the PHYSICIAN 
are limited to: 


1. Emphasizing to all concerned, 
that whatever method of treat- 
ment is used, it must comply with 
the principles of natural laws 
governing this disease. 

For example: 
and regularity of treatment is dic- 


tated by the rapid rate of propa- . 


gation of the germs that cause the 

disease, gonorrhea. 

Instructing the patient about use 

of syringe. 

3. Giving him printed instructions 
and illustrations, and seeing that 
he reads and understands them. 

4. Giving duplicate instructions and 
illustrations to nurse, or placing 
them in a sealed envelope and 
having patient deliver to nurse. 


do. A short inspection at the next 
eall and a possible explanation of 
some detail that will place the 
system of treatment on a work- 
ing basis and require a minimum 
of time and effort on the part of 
all concerned. 

6. Taking slide specimens P. R. N. 
Even when the gonococci (germs) 
are absent from the slide speci- 
mens and the urine is clear, the 
physician should continue to take 
slides daily for one week, and 
the urine and discharge should be 
clinically and microscopically ex- 
amined during the same period 
to make sure there is no recur- 
rence of the gonococci. 

7. In brief, to advising and direct- 

ing treatment. 


(B) The duties of the NURSE are 
limited to: 


1. Reading all the instructions so to 


The frequency 


iy; 
get a comprehensive ide 0 


disease and know what she 

do. | 

2. Bringing REGULARLY syrl 
and boracie acid solution, pr 
ing bath, ete. 

3. Placing in systematic order 
bedside table the articles ne 
sary for treatment and coverir 
them with a_ small opera 
sheet. 


4. Seeing that this table and article 
are kept in order as per instruc- 
tions, so that she can ascertain if 
patient is following directions re- 
garding frequency of treatment — 
and asepsis. 

5. In brief, to supervising and seeing 
that physician’s orders are car- 
ried out. 


(C) The duties of the PATIENT 
are limited to: 


1. Asking questions if he does not 
understand directions. 

2. Doing all of the detail work,— 
which he will do willingly, be- 
cause: 

a. It occupies his time. 


b. He has intelligent interest in» 
what he is doing, knows why he 
is doing it and that he is doing 
it correctly, but most of all he 
knows that he is getting full 
value for money and time ex- 
pended. 

e. His intelligence and logic have 
been appealed to, and he real- 
izes that the detailed and com- 
plete instructions employed are 
scientific and will attain max- 
imum efficiency since they per- 
mit no slacking on the part of 
physician, nurse, hospital or 
‘even the patient himself. 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 11 


INSTRUCTIONS TO PATIENT FOR TAKING INJECTIONS 


Urinate. 


Place within easy reach syringe, 
medicine, hot water or boracic 
acid solution. 


Place towel over thighs, under 
sexual organs, to protect cloth- 
ing and bed-linen. 


Place empty wash-basin over 
scrotum, under penis, so that head 
of penis is well over basin. 


Draw back foreskin well and 
clean head of penis thoroughly 
with bichloride solution from 


. basin. 


Grasp penis behind the head, with 
thumb, first and middle fingers 
of left hand, so to hold organ 
firmly. 


. Full syringe with hot water or. 


boracie acid solution. 


Place syringe to mouth of ure-. 


thra. Gently squeeze bulb of syr- 
inge until there is a feeling of 
fullness or shght pain. Hold fluid 
in urethra from one-half to one 


minute. Then remove syringe 
from mouth of urethra; let out 
fluid. Do this five or six times, 
or until the solution used for ir- 
rigation returns clear. The ure- 
thra is washed out in this way 
with hot water in order to get all 
the discharge from between the 
folds of the mucous membrane 
(lining) of the urethra, so that 
when the medicine is injected it 
will touch every part of the in- 
flamed canal and not just the top 
folds. 


Now fill syringe with medicine 
for injection. Grasp penis as 
directed in (6) and inject medi- 
cine slowly until there is a feel- 
ing of fullness or slight pain. 
When injection is in canal, re- 
move syringe, and immediately 
place first finger over mouth of 
urethra to keep in the injection. 
This injection is to be held in 
for from one to ten minutes, or 
for as long a time as physician 
directs. 


LIBRARY ~~~ 


UNIVERSITY OF ILLINOIS 


INSTRUCTIONS FOR RECUMBENT oR HOoSprTraL 


INSTRUCTIONS TO PATIENT FOR IRRIGATING 
URETHRA 


APPARATUS USED: 


Two-quart douche bag or irrigat- 


ing can, preferably the latter; glass 
nozzles, two. 


GENERAL INSTRUCTIONS: 


1. 


bo 


Before using bag, irrigating can 
or nozzel for first time, boil for 
ten minutes. 


Each time nozzle is used after 


- the first time, clean it in bichlo- 


ride solution according to direc- 
tions for keeping syringe sterile 
(see page 8). For shape of noz- 
zle to be used see illustration, 
page 18, Fig. XV. Shape of noz- 
zle depends upon size of meatus, 
or mouth of canal. 


Always let boiling or very hot 
water from tap run through can, 
bag, tube and nozzle each time 
before putting medicine in same. 


Use for irrigation, solution of 


according to doctor’s orders. 


Irrigating fluid should be as hot 
as can possibly be borne—110 de- 
grees F’. in irrigating can. © 


Test the temperature of irrigat- 
ing fluid by allowing it to run 
over back of hand before putting 


into bladder. 


Do not place fingers in can or 
bag and unsterilize same. 


If medicine burns or hurts, tell 
physician and ‘nurse. 


Metuop oF IRRIGATION: 


ah 


) 


ade 


OO 


“I 


10. 


A 


Pass all the urine in bladder. 


Hang douche-bag or irrigating 
ean up (about six feet high) in or- 
der that force may be given to 
solution. 


Sit in bed or on edge of chair, 
bath-tub, or toilet; if necessary, 
may stand. 


Place basin beneath penis so to 
eatch the irrigating fluid. 


Loosen the clasp which shuts off 
the solution. 


Control the flow by clasping the 
tube just behind the nozzle point- 
ing toward the palm of the hand. 


See that no air is left in the glass 
nozzle. Hold the nozzle in an up- 
right position and let the fluid 
flow through tube and nozzle until 
no air bubbles appear. 


Draw back foreskin. 


Grasp penis with thumb and first 
finger of left hand; wash off the 
mouth and head of penis well with 
the irrigating fluid, so that germs 
on outside of it will not be forced 
into canal and complicate disease. 


Apply nozzle loosely to the mouth 
of the urethra, meatus. 
Wash out the front part of the 


canal every......hours with 
of fluid. 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 


12. 


13. 


After repeatedly cleansing the 
front part of canal, if the method 
of irrigating posterior canal has 
been actually demonstrated, and 
if physician has instructed pa- 
tient to use it, patient is to allow 
fluid to flow back into the bladder 
until it is full. This will cleanse 
the posterior urethra. (The fluid 
will readily enter the bladder 
when the shut-off muscle is open. 
This muscle is under the control 
of the will and can be opened by 
patient thinking he is going to 
urinate. ) 


Fill the bladder every.........:......... 
hours according to physician’s di- 
rections. At time of each irriga- 
tion, fill two, three or four times. 
Irrigate gently. Never try to 
force medicine back into bladder. 
Do not allow the fluid to suddenly 


14. 


15. 


16. 


13 


distend the canal and crack the 
lining membrane. 


Irrigation completed, hang up 
douche-bag or irrigating can. 
Place clean towel over it so that 
no dirt or dust can get into it. 
This act makes it unnecessary to 
reboil douche-bag or can at each 
treatment, provided it is used for 
irrigating fluid only and is kept 
clean as directed in 3, page 12 (In- 
structions to Patient for Irrigat- 
ing Urethra). 


If these instructions are followed 
out, and irrigating can is cared 
for as directed, much time will 
be saved in not having to sterilize 
by boiling. 


If the inside of can or bag be- 
comes soiled or unsterile, clean 
same by boiling for ten minutes. 


INSTRUCTIONS FOR RECUMBENT OR HospPiraL 


.LIST OF ARTICLES NURSE IS TO PREPARE FOR PATIENT 


lorAda 


Basin (size 7” diameter, 214” 
depth) with 1/400 bichloride so- 


lution for moistening cotton 
sponges, Fig. 1. (See instruc- 
tions, p. 9.) 


Twelve pieces of loose cotton, 
approximately size of a dollar, 
to be placed in basin with bi- 
chloride solution. (See instruc- 
tions, p. 5.) 


Basin containing 12 to 20 6-inch 
squares of non-sterile gauze to 
be used as towels. 

(Crepe paper towels may be 
substituted for basin with gauze, 
Fig. II.) (See instructions, p. 
5.) . 


Basin, preferably ordinary round 
enamel wash-basin (12” diame- 
ter, 314” depth) for patient to 
use when' treating himself. After 
patient uses it nurse will cleanse 
with hot running water and re- 
place on table. 


Also unsterile hand-towel to 
protect clothing and bed-linen, to 
be placed by patient under basin. 
(See instructions, p. 11.) 


Basin for hot boracic acid solu- 
tion or hot water, temperature 
110° to 115,° for washing out 
urethra. 


Note: Total basins required 4 (only 3 if 
crepe paper towels are used). 


A quart Mason fruit-jar one-half 
filled with 1/500 bichloride solu- 
tion. “Label jar: ‘‘Poison—for 
soiled dressings,’’ Fig. III. (See 
instructions, p. 9.) 


Pitcher of water and drinking 
glass. (See instructions, p. 7.) 


10. 


as Bs 


12. 


- bichloride solution. 


An 8-ounce bottle for morning 
specimen of urine (or glass uri- 
nal). Patient is to urinate into 
bottle (or urinal) just prior to 
using protargol solution in the 
morning. This urinary specimen 
is to be saved for the physician, 
so that he can inspect progress 
of treatment. 


Note: After 12 o clock at night irriga- 
tion should be done with boracic acid or 
hot water only, so that urinary specimen 
will not retain residue of protargol. 
When specimen of’ urine is desired for 
microscopic purposes patient should not 
irrigate from midnight till 6:00 a. m., at 
which time he is to urinate into a sterile 
8-ounce bottle, after first washing mea- 
tus with a sponge from basin containing 
Save specimen for 
physician to inspect. Later send to lab- 
oratory if so desired. 


Four-ounce condiment bottle to 
contain protargol solution, la- 
beled: ‘‘Medicine for injection.”’ 
This kind of bottle is used so that 
solution can be easily taken up in 
syringe. (Fig. X.) (See instruc- 
TLONS, D. Gains 


‘Urethral bulb syringe, as made 


by Mueller & Co., of Chicago. 
(Fig. VIL.) 

Four-ounce condiment bottle 
(Fig. IX), labeled: ‘‘Poison— 
for sterilizing syringe. Don’t in- 
ject.’’ This bottle to be filled. 
with bichloride solution for ster- 
ilizing syringe as per instruc- 
tions, p. 8. Change this solution 
once in 24 hours. 


Four-ounece condiment bottle 
(Fig. XI), labeled: -‘‘Boracic 
acid solution for STERILIZED 
syringe.’’ Change this solution 
at least four times in 24 hours. 
(Fig. IX shows how syringe is 
put in bottle to be sterilized.) 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 


Wey 


14. 


15. 
16. 


ae 


18. 


’ Nurse, 


NOTE: The basin of boracic acid solu- 
tion, syringe, and bottle containing the 
syringe should be taken out of rooms by 
nurse, who will wash syringe in running 
hot water and replace in bichloride solu- 
tion until again prepared for next treat- 
ment by rinsing and putting in boracic 
acid bottle for syringe. 

Both bottles for syringe to be 
kept by nurse, who is to take 
syringe out of bichloride solu- 
tion, rinse in hot running water, 
and place in bottle containing 
boracic acid solution just before 
giving it to patient every two or 
four hours, or according to di- 
rections. 

Santal oil capsules of sodium 
bicarb. (See instructions, p. 9.) 
Ice-bag (if patient rings for it). 
Place on table for patient to use 
as directed, p. 7. 
Two hot-water bottles. 
structions, p. 9. 
Suspensory. (See instructions, 
p. 6; see Figs. IV, V and VI.) 
Bottle of red litmus paper, as 
put up by Squibb & Co. (See 
instructions, pp. 7, 9.) 

Bedside table. (See Duties of 
ae Te igs tekell: Xx LE 

-) 


(See in- 


and XI 


How 


bo 


15 


The success of treatment depends 
upon your intelligent understand- 
ing of the capse and effect of 
gonorrhea. So if you do not fully 
understand any of the instruc- 
tions, why they are given, or the 
object in giving them, you should 
at once ask the attending physi- 
cian. Also, report immediately 
if patient fails to comply with di- 
rections given. 


to Remove S7aAIns: 


A few crystals of oxalic acid 
dropped in one pint of hot water 
will make a solution that will re- 
move permanganate stains. 


Two bichloride tablets in one pint 
of hot water will make a solution 
that will remove argyrol stains. 
(If drinking glass is employed 
for making solution, extreme cau- 
tion must be exercised in wash- 
ing glass: thoroughly, for bichlo- 
ride is very poisonous and should 
be used for external purposes 
only.) 


16 INSTRUCTIONS FoR RECUMBENT OR Hosprtau 


Fig. I. Fig. II. 


° 


ai 
Diagranmn ave view \ case ey, 
of basin Showing ee ee 
‘in bichloride. Sofulion S) aS 
Diamerer of 4hasi12— J inches i 
Depth of basin 2/2 inches 4 


Crepe paper Jaw els 
gper and Joltee 


\) 


——— 


Crepe paper towels for wiping hands, see Pages 3 
and 6. 


Basin containing 1/4000 bichloride solution, 
and cotton sponge, see Page 5 


Fig. III. 


POISON 


fr SOILED DRESSINGS 


Showing adressiag and 
a ad Silke (F inch sguare) 


method. of Plating Same 
Lint or Gauze 


Boul organ but rol" 
as tightly oS 172 Cotton 


Mu str ation. 


Ww 


———— 


Quart Mason fruit jar containing 1/500 bichloride Cotton, gauze and oil silk to be applied at meatus, 
solution for sterilizing soiled dressings, see Page 5. see Page 6. 


TREATMENT OF ACUTE GONORRHEA IN THE MALE iff 


eile 
Sity Pi 
Showing suspensory with safety-pin in flap to keep Genito-urinary suspensory devised by Dr. Peterkin 
dressing in place, see Page 6. showing size of opening that will not 


constrict organ, see Page 6. 


Fig. VII. 


Fine: Fig. XI. 


Urettra/ 
Syringe 
Creeter +@) 


i, een’ -- ~Deoth 
Sf Antiseplic. 
POISON 


For STERILIZING 
SYRINGE 


MEDICINE = fF BoRAcIC ACID 
FOR : SOLUTION } 


INJECTION * FOR STERILIZED j 


SYRINGE 


4-ounce condiment 4-ounce condiment bot- 


Non - piston syringe Condiment bottle for Same bottle with bottle, the form best tle containing boracic 
with bulb, advised _ sterilizing syringe, tablet dissolved in adapted for con- acid solution, in which 
for urethral injec- showing contained it, showing method taining medicine so nurse or patient is to 
tions, see Page 8. envelope with bi- of sterilizing syr- that syringe can be place syringe after it 
chloride tablet, see inge, see Page 8. easily filled and still has been removed from 

Page 8. kept sterile, see sterilizing bottle, see 


Pages 8 and 11. Page 14. 


Fig. XII. 


Fig. XV. 


ee tes 
a ne 


12 
\ 
13 
DIAGRAM OF TABLE z 
Upper Shelf : | 
+. Basie with bickloride 
2."  * Sponges or crepe huek Nozzles for irrigating; form depending on size of 
Raa A « boracre acid So/djiopn 


4 Syringe in ‘ : meatus, see Page 12. 


S$ Tedici7e fT 12 27 jo72. / 

6. Saria/ off capsules 

J- Veale piriTeher 

es Drinking Pass 

3- Bichlorida saleuiior. for dressings 

Lower shelf. 

o- Ordinary wash -basyr2- : k 
4- Bore or glass arigl 
(2-Red lifipys paper 
9. Twels to place under basin Cas & wrigaHioj2— 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 19 


STUDY NEXT PAGE 


DIAGRAMMATIC DRAWING OF THE MALE SEXUAL 


AND URIN- 


ARY ORGANS, SHOWING THEIR RELATIVE POSITIONS 


This diagrammatic drawing (page 
20), made easily accessible when most 
needed, enables the physician to an- 
swer patient’s questions about the 
sexual and urinary organs and the 
treatment of gonorrhea, in such a way 
that his lay mind can readily grasp 
the information imparted and he ean 
follow out the instructions given. 


The article itself, on the other hand, 
presents facts concerning the rapid 
rate of propagation of the gonococci, 
ete., and thus acquaints the physician, 
nurse and patient with the necessity 


of complying with the immutable 
laws, both organic and inorganic, gov- 
erning the disease. 


Given the opportunity to acquire 
the above knowledge, the laity can 
use their intelligence and logic, and 
as purchasers can protect their lives 
and health by differentiating between 
scientific and pseudo-scientific treat- 
ment of gonorrhea, instead of relying 
merely upon the ethical standing or 
moral reputation of the followers of 
Aesculapius, who offer the treatment 
for sale. 


90 INSTRUCTIONS FoR RECUMBENT oR HOSPITAL 


DIAGRAMMATIC DRAWING OF MALE SEXUAL AND URINARY 
ORGANS 


| Kidney cael 
o~__—__ —_ 


Wrote bee) permatozoa 


4 Bladder 


ii Prostatic 
LZ Duct 


3 Seminal 

ase 10.Prostate 

Gland 

QGjaculatory Se 
Ducts _.4 Urethra 
15.Rectum . (2. Sphincter 

al i WAM Ce \e Penis 
7 Vas aS , : 
Deterens oe 
© Epididymes 5.Testi¢les 

Mien oo IZ Meatus 


4A Mucous Gland ce), 


Body cut in half from before backwards. Explanatory key on Pages 21 and 22. 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 21 


EXPLANATORY KEY TO DIAGRAMMATIC DRAWING 


bo 


4 


10. 


(FIG. XVI., PAGE 20), MALE SEXUAL AND URIN- 


ARY ORGANS, SHOWING THEIR RELATIVE 
POSITIONS AND FUNCTIONS 


Kipnry—U rine 
here. 


manufactured 


Ureter—Tube which carries ur- 
ine to bladder. 


Buiapper-—Reservoir for holding 
urine until passed. 


Urnerura—Tube which carries ur- 
ine from bladder (No. 3) and se- 
men from seminal vesicles (No. 
8) through the penis (No. 16.) 


TEsticLes —'T’ wo organs that 
manufacture semen that contains 
the spermatozoa (No. 18), the 
male seed. Made up of compart- 
ments filled with coiled tubes to- 
taling two miles in length. 


EpipipymMes—T'wo, the collecting 
tubes for semen. 


Vas DererENS—Two, transporta- 
tion tubes, continuation of No. 5. 
These carry semen from testicles 
(No. 5) to reservoirs, or seminal 
vesicles (No. 8). 


Seminat VuESICLES—Two, reser- 
voirs for storing semen until 
emptied by sexual intercourse or 
expelled during sleep (wet 
dreams) or by pressure of con- 
tents of bowels against same at 
stool—all normal acts. 


Ezacuntatory Ducts—Two, tubes 
to carry semen from reservoir 
(No. 8) to urethra (No. 4) to be 
expelled from body. Tracts se- 
men must follow: 5, 6, 7, 8, 9 and 
full length of urethra, 4. 


Prostatr GLAND—Surrounds ure- 


thra (No. 4) from bladder (No. 


ae 


3) to shut-off muscle (No. 12). 
It is made up of glands shaped 
like bunches of grapes, sixteen 
to twenty in number, which open 
into the urethra. Its secretion 
is discharged with the semen. 
This organ manufactures the 
prostate fluid (1) to dilute the 
seminal fluid so that the sperma- 
tozoa can freely move about; (2) 
to neutralize the acid secretion 
of the vagina so that it will not 
destroy the spermatozoa; (3) to 
give bulk to semen so that the 
muscles that ejaculate this fluid 
will give greater force to same, 
thereby increasing the possibil- 
ity of the spermatozoa (male 
seed) getting into the womb, and 
fertilizing the ovum (egg of fe- 
male). 

A Prostatic Duct, and its gland, 
spoken of in No. 12. 


SPHINCTER UrietHra — Shut - off 
muscle that controls urinary flow 
by squeezing together surfaces of 
urethra (No. 4). It divides No. 
4 into two parts which are termed 
respectively: Front-part, anter- 
ior urethra; and back-part, pos- 
terior urethra. This muscle is 
under the control of the mind, for 
one can urinate (empty the blad- 
der) when so desired, or hold 
urine in bladder by simply mak- 
ing up his mind to keep this mus- 
cle closed. Knowledge of the fact 
that this muscle is under the con- 
trol of the mind permits the pa- 
tient, by voluntarily opening this 
muscle, to readily irrigate the 
bladder and posterior urethra— 


bo 
bo 


14. 


‘bladder (No. 3). 


Instructions FoR RecuMBENT oR HospiTau 


a method of treatment often es- 
sential to the successful treat- 
ment of any disease of the blad- 
der and urethra. 


CowprR’s GuaNps—T'wo, one on 
each side of the body. They open 
into the urethra. 


A Mucous Guanp—!n the urethra 
(No. 4) from mouth (No. 17) to 
There are hun- 
dreds of similar glands so small 
that they cannot be seen by the 
naked eye, yet large enough to 
hold thousands of bacteria. These 
glands oil the urethra so that this 
canal can expand or contract dur- 
ing urination or intercourse with- 
out cracking the membrane, 
which would occur if it were dry. 


15. 


16. 


18. 


Rectum. End of bowels or in- 
testines and its opening (anus). 
Prenis—Organ that protects the 
urethra and.directs the flow of 
urine so as to prevent the indi- 
vidual soiling himself; also di- 
rects the spermatozoa through 
the vagina into the mouth of the 
womb, so that the ovum, or egg, 
in the woman will become ferti- 
lized. ) 

Meratus—KEind of urinary and sex- 
ual tract. (Route urine must fol- 
low; 1) 2, 3,4:and 17, | 
SprERMATOZOA—Male seed. Has 
power to move like tadpole. Rate 
of motion one inch in seven min- 
utes; 10,000 drscharged with each 
ejaculation. Size 1/500 to 1/600 
of an inch. 


2] 
to) 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 


APPENDIX 

HISTORY 
Beemer Me eeIPO TSA ar: ee a een eee Dates eines, os) 
MERE ec mrnae teem aes, Me ee ye Te oe rs INO OS ewe sae 
STULL yc), stl PRIA oi Aaa AST A auc RRS Coed CRS lO EE RN DRT 
TR vc is Sat ts 20 eR OT IR EA a A Rx AU oe a BS SP 
MSO Wel Si) oc. LS Ree ls De co ae bee A ral CE a OEE Ake 16 01 ee 
C1 Su SCOPES Res SRR OL ARMM ee Rs A HP De ace 
eas VATA se, Sea or ery tbe + GC-Complement fixation :....2......-.02.... 

Gonorrhea 
(lis (EN ie (og: Bes a a oe VBE R ph GU eo sake CM SP namiee ake CURRIN Seater meee 
PL ESAS Tie 22) AM SESE oc ei Pe COPY. RUE a SA ea 
Poti earn eS OE (ioe Mech eel og, Go AGL a ee ee pera i Sek 
ret eee CEY TGS) a aie AC ete ae eo Mu wl) et ee ae 


"HISTORY Continued 


f “al it Pad ©] 


Sie 


ae 2 
ee 
ig 


bo 
On 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 


SPECIAL INSTRUCTIONS OF ATTENDING PHYSICIAN 


ON an 


TREATMENT OF ACUTE GONORRHEA IN THE MALE 


INDEX 


PAGE 

MmIGOHOLs MUSE NOt US O..--c. 5 c----2-xeceseteseranecenveees 7 
Apparatus used for irrigating urethra........ 12 
Articles nurse is to prepare for patient...... 14 
Nurse is to place on bedside table.......... 5 
Baths, Hot Sitz, instruction for taking........ 8-9 


Blindness caused by gonorrheal discharge 5 


Bottle, hot-water, apply to perineum and 
[URMLOVS SI = Oe oR SRT Oe cee ee ae 9 


CWC Lom GCAt Og Ole tt om t,o Soe eens eee 9 


Cotton, medicated, instructions for using 5 


WO ONGCHMOlE SIMS tee oes on el ee eee 6 
TORREY: ster toe eli eat a ea ne ih 
Resse s PaADDIIGALION ‘OL 20.0. 222..---ece.-c stn Ae 5-6 
Duties of physician, nurse and patient........ 10 


Efficiency principles must govern scientific 
treatment, Of GISCASE.....2 2. .-.-2ac2ee-coe- ee - ale A 


Eryections aggravate and prolong the dis- 
SAS Cun Oreniie Fe MeV Fh Rd oy th oe 6 


LOND TeVGMtCd: sleek eee 8 6-7 


Explanatory key to diagrammatic drawing 


of male sexual and urinary organs...... 21-22 
Foreskin, long, keeping cotton over............ 5 
Mowraress: penis awalhout.:2 32.8 6 


Gonococci, destruction of by medicated 
(LOTS RGU Ee at pe ee Pea ale Pe ae tte ete oe eo 6 


Gonorrhea, why author chose to write 


LOGU Ces ettee eee a tates DAE RA) ee oe yA 
Not contagious, but communicable.......... 5 
History sheets (memoranda)................-.......-- 23-24 
Hospital treatment of gonorrhea ...........2.... 258 
Infection, mixed, prevention of._.................... 6 
COUR ENACT) Sah Saal Oe AL aN Ta Re OE ae es ele 6 
Injections, instructions to patient for 
(TUONO ot Ne LE eee Ares, A Pee 11 
Instructions, after doctor has given........... 
For keeping nozzles sterile.__.................. 12 


27 
PAGE 
For keeping syringe sterile.................... 8 
AROS TT Tare, Bret rte hes gnc genet se ees aye et 5 
Special, of attending physician....._............ 29 
To patient for irrigating urethra................ 12 
To patient for taking injections................ ld 
Litmus paper, test of urine with.................. feos) 
Meatus, changing dressing about.................. 6 
Preventing discharge caking.................... 6 
Wheremilocdted) Rac ves ows ae eee 22 
IMEC GIGS LHCII 6 tee pee pea retreive Sate A eee ee it 
Medicine, demand for scientific.................... 1-2 
INJECTION cOL, ee ea ate ee oe ee SA Soe 
Nozzlés: kind! tisedges. 212s =. ee eee 12 
Instructions for keeping sterile............... 12 
Norse, (dutiess oly seeker ae eee STi teat Nt) 
List of articles she is to prepare................ 14-15 
Must realize necessity of applying 
treatment, rezularly Be 2 42 eee 8 
Orzganization..of medicine. 5. eee 1-2 
Patient tcontined to 2bed (ee see een tee 5 
Duties Mor #iuklaceck ee er ees ee eee 6-7, 1 
TSE LI ONS Op eee ee eee oe Aalto MR 11-12 
Physician. duties: Ole) 2 es eens Se 10 
IPTOGINE BURG Sysstat ee ee ee 1-3 
Stains show. tor remover 2a ee eae 15 
Standard, creation of in medicine................ i) 
Suspensory, directions for using.................... 
WING MUSOU cape eee es a ee Pe Wh wk 
Syringe, howl stenilizedae. 2 a es 
Instructions for keeping sterile................ 
FRING SCCM Sans SS eee ee ee ee ei 
Table, bedside, articles nurse shall 
DIAGEO OT aes ee AER Ss Rae 5 
MreAtment ) CONSLEUCION A] yee eee eens 
Blospital ty. 238 dace Se ee re 2, 
Mechnique sO POCA s ss western eee 
Urethra, anterior, washing with boracic 
UCT Sah eae od Carey. eine RAS, bea aer ea pee ks 8 
Postervion, -irriga tion. Ofve eee 1053 


Water, reason for drinking large amount 7 


Upo 


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QQ, additional copies of this pamph- 
aid. When ordered in quantities 


eceipt of $ 


a 


ed postpaid. When it 
onately. Address all orders: 


IRS 


educed proporti 
‘Tun Aurion, ea 
Seattle, Washington. 


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